In the German national health service, is the medical care available to over a quarter of the German population, to the socially disadvantaged, being restricted?

Written by, and translated from the German original by, Dr. Angelika Schaumberg

There are indications, that services provided by the national health service in Germany are already being rationed. In a nationwide survey, over three quarters of the surveyed hospital doctors stated that they have to deny useful treatments to patients covered by national health insurance, for cost reasons {1}.

Every fifth patient covered by national health insurance stated in an interview that when visiting doctors in the past year the services available to them were being limited. The patients were then often asked to themselves pay for the denied service {2}.

But we are on the way to a better future with the help of Manfred Davidmann's concern and investigations about the underlying causes of, and solutions for, today's problems. If you want a good life in a free, fair, just and democratic community and society, read on.

Content

If services provided by the national health service are being rationed in Germany, how many people would then not be able to pay by themselves for the denied services?

What impact has poverty on health?

Are we lacking finance?

And where do these moneys come from?

How much is in fact and comparatively being spent on health in Germany?

What are the implications for German hospitals?

Have fewer patients been treated during this period?

How is this possible?

Overview

What consequences could this have for the treatment of the patients?

What are the consequences for doctors?

What about the hospitals?

To what extent is the health service being supported by the government?

Summarizing

Analysis and evaluation

Conclusions

References
Terms of Use
Overview page

If services provided by the national health service are being rationed in Germany, how many people would then not be able to pay by themselves for the denied services?

About two thirds of Germans above the age of 17 had (2007) no, or only very little, money or assets {6}. And one out of eight is relatively poor. Without support from the state as many as every fourth would be affected. A person is considered to be relatively poor who has less than 60% of the average net income available (about 781 Euro per month). Particularly at risk are the unemployed, single parents, people with low qualifications or immigrant background {3, 10}.

What impact has poverty on health?

Cancer patients of socially disadvantaged population groups generally have lower survival rates than patients who are better off, writes the pharmacist's magazine (Apothekenrundschau) and refers to a study published in the British Journal of Cancer {25}. In the German magazine for doctors (Deutsches Aerzteblatt) one read that life expectancy in the top income groups was up to 10 years higher than in the lowest income groups {4}, and that already the practice fee of 10 Euro per quarter year can make access to the German national health service more difficult for chronically ill patients with low incomes. They therefore tend to postpone or avoid going to the doctor {5}.

Even the German government is aware that poverty increases the risk of being ill, of dying earlier and halves the chance of having good or very good health! {3}

Are we lacking finance?

During the so-called financial or economic crisis governments, including the German one, provided many thousand million Euro as aid money for banks and companies. The German rescue fund for banks SoFFin (Sonderfonds Finanzmarktstabilisierung) makes available for stabilization, up to 480 000 million Euro {9, 24}. Per inhabitant this is equal to approximately 5 854 Euro. The Hypo Real Estate bank, on its own, was supported with 100 000 million Euro. Also other banks like Commerzbank, BayernLB (15 000 million Euro) und HSH Nordbank (30 000 million Euro) benefited from the rescue fund's guarantees {12}.

In addition, the German government made available 115 000 million Euro for corporate financial support to the economy fund Germany (Wirtschaftsfonds Deutschland) and to the KfW-Sonderfonds fuer Mittelstaendler {13, 24}.

What are banks and companies actually doing for us, the citizens?

And where do these moneys come from?

In Manfred Davidmann's comprehensive and objective report 'The World at War! Multinational (Global) Operations, and Government Of, By and For the People' {7} you find answers which are eye-opening!

One thing is obvious: The national debts per inhabitant in Germany is rising dramatically, and is meanwhile stated by the taxpayers' organization (Bund der Steuerzahler) as being almost 20 000 Euro, a burden to be carried by many generations to come! The taxpayers' organization writes appropriately: 'The debts of today are the taxes of tomorrow' {8}.

How much is in fact and comparatively being spent on health in Germany?

In 2007 the expenditure for health in Germany amounted altogether to 252 800 million Euro, which is equivalent to about 3 083 Euro per inhabitant {11}. More than half of it is provided by national health insurance, that is by the insured and their employers, the rest being provided mostly by private households and organizations, care insurance, private health insurance.

Between 2000 and 2007 the expenditure on health in Germany rose in real terms by an average of only 1,4% per year. In 30 comparable countries there was an average increase of at least 3,7% per year. In comparison to these countries the German increase was the lowest in this period. So concerning expenditure on health Germany is only in the tenth position {15}.

What are the implications for German hospitals?

In 1991 we still had 2 411 hospitals, in 2006 there were only 2 104 (-12,7%). In 1991 we still had 665 565 hospital beds or 832 per 100 000 inhabitants. In 2006 this had dropped to only 510 767 hospital beds or equivalent 620 per 100 000 inhabitants (-25,5 %) {17}.

Have fewer patients been treated during this period?

No. On the contrary, the number of patients treated increased from 14 577 000 in 1991 by 15,5% to 16 833 000 in 2006 {17}.

How is this possible?

In 1991 patients were treated in hospital for an average of 14 days, in 2006 the duration of stay had been reduced to 8,5 days, corresponding to a reduction of almost 40 %! {17}

In addition the number of people working in hospitals had been reduced from a total of 1 161 863 employees in 1995 to 1 071 995 in 2006 {18}.

Overview:

What consequences could this have for the treatment of the patients?

The work-load of hospital staff during this period seems to have increased substantially. According to the 'Deutsches Aerzteblatt' (German magazine for doctors) it has risen to a peak in comparison with all other industrialized nations: in Germany a hospital employee cares for an average of 20 patients, in the United States of America it is eight patients per employee and in Switzerland nine  patients {20}. The staff has less time available for each patient.

As a consequence the quality of the treatment of the patients is likely to suffer. 65 % of doctors working outside the hospital service and 48 % of hospital doctors consider that the quality of the national health service being provided has deteriorated {22}.

And more mistakes could occur during treatment.

Also, waiting lists could multiply, especially for non-acute treatments such as hip replacement and cataract operations.

What are the consequences for doctors?

When doctors have less time and money available for treating their patients what could happen is that their patients could only be treated as if they were on a conveyer belt.

Doctors are working under constantly increasing pressure. There are strong indications that more and more doctors are leaving Germany to work abroad. When something similar happened in England it was called the 'brain drain'.

And what about the hospitals?

Meanwhile even the survival of many German hospitals is under threat. The existence of one in five hospitals seems to be under threat in the near future {21}. For this reason the largest protest rally in the history of the German national health service took place in the autumn of 2008: 130 000 hospital employees demonstrated together with their employers (!) for adequate funding of hospitals {14}.

To what extent is the health service being supported by the government?

The German government made available an additional 3 500 million Euro for modernizing municipal infrastructure, including hospitals {19}. The health fund (Gesundheitsfonds) provides money to the health insurers (Krankenkassen) for their policyholders. The government expects to pay an additional 7 200 million Euro for 2009 to this health fund from its tax income and is planning to again pay about 11 800 million Euro for 2010 {16}.

According to the Federal Ministry of Health, the health service is the largest economic sector in Germany {23}. In 2006, 4,3 million people were working in the national health service, every ninth employee in Germany {17}.

Summarizing (based on about 82 million inhabitants in Germany {26}):

Analysis and evaluation

To reduce government expenditure by only cutting social services like the national health service, is one-sided, writes Manfred Davidmann {7}. Why are on the other hand each year vast sums which originate from the people, being handed over to a selected few, such as owners, shareholders and those who control financial institutions? These very large payments could also be reduced.

In the objective and comprehensive report 'The World at War! Multinational (Global) Operations, and Government Of, By and For the People' {7} about the background of the financial crisis Manfred Davidmann describes in clear and easily understood language, that the task of any government is to balance income and expenditure of the state and to improve the standard of living of its citizens. If unsuccessful then, just like in any commercial enterprise this is most likely the result of bad management and leadership, including consulted experts and advisers.

Manfred Davidmann's works about multinationals are very informative, for example about how they avoid paying taxes, how they cause unemployment in Germany by transferring production into low wage countries, and how the resulting costs have to be taken on by the taxpayer.

Such companies are sometimes paying wages which are so low, that the government provides supplementary income-support benefits taken from taxes to provide a poverty-existence level.

Manfred Davidmann asks penetrating questions:

Why is the government spending more than its income?

Why are we being indebted more and more by the government?

Why are the citizens not being asked, whether and how payments for companies should be made?

Who pays how much tax?

Who is not paying and should?

Who should pay more?

Who benefits from this distribution of the tax load and the benefits?

Manfred Davidmann suggests, that the government should set an example of good housekeeping by giving each citizen the choice of opting out of donating to the aid-funds for needy companies and financial institutions.

Conclusions

Health and a good and comprehensive national health service are of great importance to every person during his life. After all, about every ninth employee in Germany is working in the national health service.

Why does the German government not provide enough money for the national health service, to guarantee also a future good and comprehensive medical care for all citizens?

After all, why are we not being asked, what our hard earned tax money is to be spent on? Do we really want that the German government to support unsuccessful banks and companies with thousands of million Euro?

Do we really want that in future every fourth in Germany will receive only limited services provided by the national health service because of rationing (prioritizing!)?

Or do we want to make sure, that also in future every person in Germany is provided with good and comprehensive services provided by the national health service, to prevent every fourth German being excluded from necessary services by rationing (prioritizing!)?

References